Effective Strategies for Sedation During Bronchoscopy

Studies indicate that sedation during bronchoscopy makes the procedure more comfortable for patients and provides better working conditions for physicians when compared with no sedation. Sedation can be used during most bronchoscopies with minimal risk. However, research suggests that use varies widely between geographic areas of the country and within institutions. Survey results from 1991 showed that sedation was administered to more than half (51%) of bronchoscopy patients, but data from more than a decade later revealed that this figure jumped to nearly three-fourths of patients (73%). It’s not known if the use of sedation during bronchoscopy is continuing to rise. Optimizing Use of Sedation During Bronchoscopy In the November 2011 issue of Chest, my colleagues at the American College of Chest Physicians and I had a consensus statement published on the optimal use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adults. The statement recommends that every bronchoscopy be performed with sedation if feasible because it improves patient satisfaction and procedural tolerance significantly. It should be noted, however, that patient circumstances and access to resources may prevent use of sedation during these procedures. Patients with numerous comorbidities or severe, restricting respiratory or cardiac issues may not be appropriate because of potential complications. Although it’s acceptable to fulfill the wishes of patients who don’t want to be sedated, research suggests that topical anesthetics should be used for everyone receiving bronchoscopy. If patients have allergies to lidocaine—the preferred topical anesthetic for bronchoscopy—use of other topical anesthetics may be explored. Anticholinergic agents, however, are discouraged for pre-bronchoscopy use because data have shown that they fail to produce a clinically...